Headaches describe a pain that manifests in the head. Headaches are a very common complaint affecting up to 2/3 of the adult population and is both debilitating for the sufferer and for the people around them.

There are hundreds of different headaches but they all fit into 3 categories;

  1. Primary headaches(including migraine, tension-type headaches, cluster headaches,)
  2. Secondary headaches(including cervicogenic headaches, headaches resulting from head or neck injury)
  3. Cranial headaches, neuralgias and other headaches.

Physiotherapy can help with 2 types of headaches.

  1. Tension headaches.
  2. Cervicogenic headaches.

Tension-type headaches

A tension headache is the most common type of primary headache, its lifetime prevalence in the general population ranges in different studies from 30 to 78%.

Tension headaches may occur when:

  • Neck and scalp muscles become tense, or tight. The muscles tighten in response to stress, sustained poor posture, anxiety, and fatigue.

There are many other theories put forth to the cause of tension-type headaches. One of which indicates the over activity of the temporalis muscle by clenching teeth is a cause of a tension headache.

Cervicogenic headaches

Cervicogenic headache is a referred pain to the head, that is caused by:

  • Problems in the muscles including trigger points, joints, fascia and neural structures of the neck.
  • C2 nerve root irritation(see: Acute nerve root pain).
  • These problems can occur as a result of these structures being compressed/compromised/injured following poor sustained posture(work posture), degenerative joint disease, trauma to head and/or neck(see: Whiplash).

Combined headaches

The confusing aspect to headaches is that more than one type of headache can co-exist for e.g. a patient can present with a migraine headache that is chronic and have been recently in a car accident and have a cervicogenic headache. This is where a comprehensive examination and history is essential in proper treatment.

Headaches can also be caused by sinister disease processes so a doctor may need to be involved in some cases.

Some of the symptoms indicating further investigation are;

  1. Headaches associated with sudden weight loss, fever.
  2. Headaches presenting with neurological symptoms.


Tension-type headache

Common symptoms include;

  • A tight band like bilateral, top, front or entire head, headache.
  • May last from 30min to several days.
  • Tension headaches typically do not stop a patient from performing their everyday duties.
  • Typically do not include nausea, photophobia and light headedness.

Cervicogenic headache

Common symptoms include;

  • Pain often starts in the neck and spreads to the head.
  • Constant, steady dull ache.
  • Can be accompanied by neck pain or stiffness and can be aggravated by neck movements.
  • Usually of gradual onset.
  • Can go on for days, weeks and months if left untreated.
  • Associated with light headedness, dizziness, tinnitus(ringing in the ear), nausea maybe present.
  • Impaired concentration.


The key to treating headaches successfully is in the examination, an accurate diagnosis must be made due to the multiple nature of headaches.

Physiotherapy treatment(see our ethos) consists of;

  • Mobilisations to restore movement to stiff joints.
  • Stretching of tight neck muscles.
  • Massage to relieve tight muscles and trigger points and fascia.
  • Neural stretching.
  • Postural education/training.
  • Strengthening of deep neck stabilisers.
  • Home management education.